Unexplained infertility is often anything but unexplained. In this episode of the Hormone Puzzle Podcast , Dr. Karli Goldstein joins host Dr. Kela Smith to explore one of the most common—and most overlooked—drivers of fertility challenges: endometriosis.
Here are five takeaways every fertility-focused patient deserves to hear.
1. Unexplained infertility often has a cause, it’s just not being looked for.
Dr. Goldstein shares that up to 50% of patients diagnosed with “unexplained infertility” may actually have undiagnosed endometriosis. These are often patients with normal hormone labs, open fallopian tubes, and embryos that look good on paper—but they’re still not conceiving. The missing piece is that no one has evaluated for inflammatory or structural issues in the pelvis that imaging can’t detect.
“Unexplained doesn’t mean there’s nothing there. It just means no one’s looked in the right place yet.”
2. You don’t need to have painful periods to have endometriosis.
One of the most common misconceptions is that endo only shows up as severe cramping. But as Dr. Goldstein explains, many patients—especially those with fertility struggles—experience symptoms that aren’t always recognized as hormonal, like cyclical bloating, fatigue, or back and hip pain around ovulation. Some have no pain at all. These are signs of what’s often called “silent” endo, and they’re easy to overlook if you’re only scanning for textbook symptoms.
3. Bloodwork and imaging can’t yet diagnose endometriosis, but surgery can.
Standard fertility workups rely on ultrasound, hormone levels, and HSGs. But these tests miss most cases of endometriosis. The only definitive way to diagnose and treat it is through laparoscopic excision surgery, where trained surgeons can visually assess and remove lesions in the same procedure. For patients who’ve had multiple failed transfers or unexplained inflammation, this is often the turning point in their journey.
4. Surgery won’t delay your fertility timeline—most patients try again within two weeks.
Dr. Goldstein emphasizes that recovery from excision surgery is often quicker than expected. Patients typically go home the same day and resume walking, working, and even trying to conceive, within 10–14 days. Many see pregnancy within 1–3 cycles. The idea that surgery delays treatment is outdated; for many, it’s what finally makes treatment work.
“This isn’t a setback. It’s a reset—and for a lot of people, a breakthrough.”
5. Fertility support should treat more than just your ovaries.
At ESSE Care, fertility support goes beyond medication and procedures. Dr. Goldstein shares how strength-based movement, targeted nutrition, acupuncture, and emotional regulation help lower inflammation and balance the nervous system—crucial for both egg quality and implantation. These aren’t “extras,” they’re essential tools for long-term health and fertility.
If you’ve been told your infertility is unexplained, or if you’ve gone through cycles without answers, there is more to explore, and more care available than you’ve been offered.
